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In 2015, a range of congenital anomalies resulting from mother-to-child transmission of the zika virus emerged. Later called congenital zika syndrome (CZS), the condition includes microcephaly. Since then, around 4,000 children have been affected in 27 countries, with Brazil accounting for the largest proportion of cases. Family caregivers have also been affected. This study analyzes the literature on caregivers of children with CZS and how the disease has affected their everyday lives. We conducted an integrative review using the PubMed, Virtual Health Library, and Embase databases. Thirty-one articles were identified for analysis after screening. The findings were grouped into four categories: a) social impacts - changes in family relationships, life projects, and social life; b) subjective impacts - feelings of resilience, loneliness, grief, overburdening, fear, uncertainty, and spirituality and religion; c) economic and material impacts - loss of income, increased household expenses, change of residence, and unemployment; and d) health impacts - service unpreparedness, selflessness, self-care, changes in nutritional and sleep patterns, and mental health problems, including stress, anxiety and depression.

Resumo Analisou-se, a partir das dimensões disponibilidade-acomodação e adequação, o acesso das Pessoas com Deficiência (PcD) aos serviços de atenção especializada. Trata-se de estudo de caso de abordagem qualitativa com triangulação de fontes a partir de pesquisa documental, dados dos Sistemas de Informações em Saúde e entrevistas semiestruturadas com gestores, profissionais de saúde e PcD. Observou-se a ampliação de serviços de reabilitação no Recife, embora não tenha sido possível analisar a capacidade de produção de tais serviços. Os achados apontam para a existência de barreiras arquitetônicas e urbanísticas e insuficiência de recursos nos serviços estudados. Ademais, há um longo tempo de espera para atenção especializada e um difícil acesso às tecnologias assistivas. Pôde-se observar ainda que os profissionais têm baixa qualificação para atender às necessidades das PcD e não se tem instituído um processo de educação permanente para os trabalhadores dos diversos níveis de complexidade. Conclui-se que a instituição da Politica Municipal de Atenção Integral à Saúde da PcD não foi suficiente para garantir o acesso aos serviços de saúde com continuidade do cuidado, considerando a permanência da fragmentação da rede de atenção, ferindo, assim, o direito à saúde deste segmento.

Resumo Em 2015, um espectro de anomalias congênitas, incluindo microcefalia, acometeu recém-nascidos como resultado da transmissão vertical pelo vírus zika, posteriormente denominada síndrome congênita do zika (SCZ). Desde então, cerca de 4 mil crianças foram afetadas em 27 países, sendo o Brasil o mais atingido. Cuidadores familiares também têm sido impactados. Esse estudo analisa publicações científicas que investigam as maneiras como a doença afetou as dinâmicas de vida de cuidadores familiares de crianças com SCZ. Realizou-se uma revisão integrativa de literatura consultando as bases de dados PubMed, Biblioteca Virtual em Saúde e Embase. Após as etapas de triagem, foram identificados 31 artigos. Os principais resultados foram agrupados em quatro categorias: a) impactos sociais que evidenciaram mudanças nas relações familiares, nos projetos de vida e no convívio social; b) impactos subjetivos - sentimentos de resiliência, solidão, luto, sobrecarga, medo, incerteza e relação com a espiritualidade; c) impactos econômicos e materiais - perda de renda, aumento de despesas, mudança de moradia e desemprego e d) impactos na saúde - despreparo dos serviços, renúncia do cuidado de si, modificações dos padrões nutricionais e de sono, repercussão para a saúde mental e níveis de estresse, ansiedade e depressão.

The purpose of this article is to analyse the circumstances in which the National Health Policy for Persons with Disabilities (PNSPCD) came into place in 2002 and the factors supporting or impeding its implementation from 2002 to 2018. The analysis was based on the Comprehensive Policy Analysis Model proposed by Walt and Gilson and focussed on understanding the context, process, content and actors involved in the formulation and implementation of the Policy. Data were obtained from two sources: document analysis of the key relevant documents and seven key informant interviews. Content analysis was undertaken using the Condensation of Meanings technique. The research demonstrates that the development and implementation of PNSPCD is marked by advances and retreats, determined, above all, by national and international macro-political decisions. The policy was formulated during Fernando Henrique’s governments, under pressure from social movements and the international agenda and constituted a breakthrough for the rights of persons with disabilities. However, progress on implementation only took place under subsequent centre-left governments with the establishment of a care network for people with disabilities and a defined specific budget. These developments resulted from the mobilization of social movements, the ratification of the United Nations Convention on the rights of people with disabilities and the adherence of these governments to the human rights agenda. The coming to power of ultra-right governments triggered fiscal austerity, a setback in the implementation of the care network and a weakening in the content of various social policies related to the care of people with disabilities. During this era, the political approach changed, with the attempt to evade the role of the State, and the perspective of guaranteeing social rights. Undoubtedly, the neoliberal offensive on social policies, especially the Unified Health System, is the main obstacle to the effective implementation of the PNPCD in Brazil.

Antecedentes: A pesar de que la fluoración del agua de abastecimiento público sea reconocida como una excelente medida preventiva para el control de la caries dental, se sabe que el estado de Pernambuco no realiza monitoreo sistemático de los niveles de fluoruro en sus aguas. Objetivo: El objetivo de este estudio es describir y analizar los niveles de fluoruro (F) en las fuentes de agua y suministro público de agua en municipios del primer macrorregión de salud de Pernambuco, con 50.000 habitantes o más. Métodos: Este es un estudio descriptivo que combina información del Instituto Brasileño de Geografía y Estadística y el Sistema Nacional de Información de Saneamiento con datos de Compañía Pernambucana de Saneamiento, el proyecto VIGIFLUOR y el Sistema de Información de Vigilancia de la Calidad del Agua para el consumo Humano. Resultados: El análisis de los datos indicó la presencia de F natural en contenidos insignificantes o mínimos en la mayoría de los municipios estudiados. Además, se encontraron tres niveles de máximo beneficio para la prevención de caries, pero esta concentración no llega a la población vía abastecimiento público. Conclusión: Los resultados demuestran que los niveles F de la red pública de abastecimiento de los trece municipios analizados no contribuyen a la protección de la población. Este enfoque destaca la necesidad de que el suministro de agua a los municipios de la 1ª macrorregión de salud sea fluorado artificialmente; y también puede ser bueno, para asegurar a la población el acceso a agua tratada y fluorada de calidad, que se establezca un mecanismo de vigilancia a través de programas de heterocontrol.

RESUMO Objetivou-se analisar a atenção especializada em saúde mental da cidade do Recife e seu processo de regulação assistencial. Trata-se de um estudo qualitativo, realizado por meio de análise documental, observação, entrevistas semiestruturadas e diário de campo. Os sujeitos da pesquisa foram gestores e profissionais da Rede de Atenção Psicossocial e da regulação em saúde do Recife. Trabalhou-se com análise de conteúdo do tipo temática, a partir da técnica de condensação de significados. Apesar do histórico de alinhamento com a Reforma Psiquiátrica Brasileira e dos avanços nos processos de desinstitucionalização, a cobertura dos Centros de Atenção Psicossocial/tipo III é insuficiente e há fragilidades de comunicação entre os componentes da rede. Além disso, os ambulatórios de saúde mental atuam em complementaridade ao modelo manicomial. A regulação assistencial é incipiente na saúde mental e centrada no fluxo de marcação de consulta especializada, sem dispositivos de conversação entre os profissionais. Portanto, a atenção na saúde mental com suporte logístico da regulação assistencial se configura como um desafio para a gestão municipal. Por último, ressalta-se que as fragilidades na organização da rede na cidade do Recife podem, ainda, ser agravadas pela agenda antirreformista que vem instituindo mudanças na Política Nacional de Saúde Mental no Brasil. ABSTRACT The objective was to analyze the specialized mental health care in the city of Recife and its assistance regulation process. It is a qualitative study, carried out through document analysis, observation, semi-structured interviews and field diary. The research subjects were managers and professionals from the Psychosocial Care Network and health regulation in Recife. Thematic content analysis was performed, based on the condensation of meanings technique. Despite the history of alignment with the Brazilian Psychiatric Reform and the advances in deinstitutionalization processes, the coverage of the Psychosocial Care Centers/type III is insufficient and there are weaknesses in communication between the components of the network. In addition, mental health clinics are complementary to the asylum model. Assistance regulation is incipient in mental health and centered on the flow of scheduling specialized consultations, without devices for conversation between professionals. Therefore, mental health care, with logistical support for assistance regulation, is a challenge for municipal management. Finally, it is emphasized that the weaknesses in the organization of the network in the city of Recife may, still, be aggravated by the anti-reform agenda that has been instituting changes in the National Mental Health Policy in Brazil.

RESUMO Pesquisas internacionais e nacionais apontam o aumento expressivo de mulheres com consumo abusivo de álcool, e este consumo gera danos sociais, psicológicos e biológicos em suas vidas. O objetivo do presente estudo foi avaliar os padrões do consumo de álcool por mulheres cadastradas nas Unidades de Saúde da Família no município do Recife (PE). Trata de um estudo exploratório descritivo de abordagem quantitativa, que provém de uma pesquisa original, através de uma amostra definida de 864 mulheres com idades iguais ou superiores a 18 anos. Utilizou um questionário sociodemográfico e o Teste para Identificação de Problemas Relacionados ao uso do Álcool. Os padrões de riscos encontrados entre as participantes foram: 57,9% não bebem; 23,7% bebem de baixo risco; 11,9% bebem de médio risco; e 6,3% bebem de alto risco; predominantemente mulheres jovens, na faixa etária de 18 a 39 anos; sem trabalho e com ensino fundamental. Verificou-se que 54,93% faziam uso abusivo de bebidas alcoólicas em dia típico e 22,93% sofreram ocorrência de apagão alcoólico. Esses resultados evidenciam a importância da elaboração de estratégias de cunho preventivo e da redução de danos diante do beber, para a assistência à saúde da mulher. ABSTRACT International and national surveys point to the significant increase of women with alcohol abuse, and this consumption generates social, psychological and biological damages in their lives. The objective of this study was to evaluate the patterns of alcohol consumption among women enrolled in the Family Health Units in Recife (PE). It is an exploratory descriptive study with a quantitative approach, which comes from an original survey through a defined sample of 864 women aged 18 years or older. It used a sociodemographic questionnaire and the Test for Identification of Problems Related to the use of Alcohol. The risk standards found among participants were 57.9% do not drink; 23.7% drink at low risk; 11.9% drink at medium risk; and 6.3% drink at high risk; predominantly young women, in the age group 18 to 39; without work and elementary school. It was verified that 54.93% made abusive use of alcoholic beverages in a typical day and 22.93% suffered an alcoholic blackout. These results evidence the importance of elaborating preventive and harm reduction strategies in relation to drinking, for women’s health care.

BackgroundThe aim of this paper is to estimate the economic burden of children with congenital Zika Syndrome (CZS) in Brazil over 5–10 years.MethodsWe conducted a modelling study based on data collected in a case–control study in Brazil, including children with CZS (cases) and typically developing children (controls), born in 2015 and 2016. In total, 484 participants were recruited in two sites, Recife and Rio de Janeiro. Social and economic information was collected in a survey from the carers of cases and controls, and detailed healthcare utilisation was recorded for each child in the Rio de Janeiro cohort prospectively in a database. We used this information to estimate the cost per child with severe, moderate and no CZS and incremental cost per child with severe and moderate versus no CZS from a disaggregated societal perspective. These estimates were incorporated into an economic burden model to estimate the incremental burden of the CZS epidemic in Brazil over 5 years and 10 years.FindingsThe societal cost per child with severe CZS was US$50 523 to 10 years of age (born in 2015 and 2016), substantially higher than the costs for moderate CZS (US$29 283) and without CZS (US$12 331). The incremental economic burden of severe versus no CZS in Brazil over 10 years was US$69.4 million from the household and US$129.0 million from the government perspective. For moderate CZS, these figures amounted to US$204.1 million and US$86.6 million. Over 10 years, 97% of the total societal economic cost of severe CZS is borne by the government, but only 46% for moderate CZS.InterpretationThe economic burden of CZS is high at the household, provider and government levels. The compensatory government payments helped to alleviate some of the additional costs incurred by families with a child qualifying for the disability benefits, and could be scaled to include the children with moderate CZS.

Primary health care is an essential component of effective health systems. The aim of this study aim was to evaluate the quality of primary care in a city in the state of Pernambuco, Brazil. We conducted an exploratory study with 525 service users using structured questionnaires. The quality of primary care was assessed across five dimensions: accessibility, clinical care, professional-user relations, community activities and structure. The findings point to the perpetuation of social vulnerabilities and challenges in achieving equitable universal care. Dissatisfaction rates were highest in the following categories: access to specialist appointments and exams, appointment wait time, and opportunity to make complaints. However, respondents were satisfied with medical and nursing care, particularly in relation to respect, privacy, listening and confidentiality. The findings show that, although health professionals were committed to providing humanized care, fragmentation of care is evident, hampering the provision of adequate and timely follow-up and negatively affecting the quality of care.A Atenção Primária à Saúde (APS) é considerada imprescindível para a efetividade dos sistemas de saúde. O objetivo deste estudo foi avaliar a qualidade da assistência prestada na APS em um município de Pernambuco. Realizou-se um estudo exploratório através da escuta a 525 usuários utilizando questionários estruturados. A avaliação da qualidade considerou as dimensões: acessibilidade, assistência clínica, relação profissional-usuário, atividades comunitárias e estrutura. Os resultados apontam para um contexto de perpetuação das vulnerabilidades sociais e o desafio em alcançar um atendimento equitativo e universal. Os principais aspectos de insatisfação foram: dificuldade de acesso a consultas e exames especializados, tempo de espera para atendimento e possibilidade de apresentar reclamações. Por outro lado, os entrevistados apresentaram-se satisfeitos com o atendimento médico e de enfermagem, principalmente quanto ao respeito, privacidade, escuta e confidencialidade. Verificou-se que apesar dos profissionais de saúde se empenharem na prestação de um atendimento humanizado, foi evidente a fragmentação do cuidado na rede estudada, o que dificulta o seguimento adequado e oportuno ao paciente, refletindo negativamente na qualidade da assistência prestada.

O objetivo deste trabalho foi realizar um levantamento dos principais problemas e conflitos socioambientais existentes no litoral de Goiana-PE com o intuito de contribuir com novas informacoes para os gestores do municipio, mas tambem podendo auxiliar a populacao litorânea na mediacao dos conflitos e problemas socioambientais existentes. A abordagem metodologica seguiu o vies do planejamento estrategico participativo. Adotaram-se os seguintes procedimentos: visitas de campo, coleta de dados primarios e secundarios, realizacao de oficina e seminario de validacao dos resultados, com a participacao da populacao. Como principais resultados verificou-se que o litoral de Goiana possui mais problemas que conflitos socioambientais, embora estes nao estejam ausentes. Os maiores problemas e conflitos referem-se a precariedade do saneamento ambiental, a expansao urbana, a poluicao dos recursos hidricos e a degradacao dos ambientes naturais, como o mangue e a mata atlântica. Concluimos que muitos dos problemas diagnosticados sao causas para possiveis futuros conflitos e os conflitos existentes sao mediados pelo poder publico, que acaba decidindo com base nos seus interesses. A populacao pobre e a que mais sofre com os problemas existentes, absorvendo o onus da degradacao ambiental no litoral, entretanto ainda nao ha um enfrentamento organizado dessas comunidades para superar os problemas e mediar os conflitos. A B S T R A C T The aim of this paper was to perform a survey of the main socio-environmental problems and conflicts in the coast of Goiana-PE in order to contribute with new information for municipal public policies, but also to help the beach population in the mediation of existing conflicts and socio-environmental problems. The methodological approach followed the bias of participatory strategic planning. It was adopted the following procedures: field visits, collection of primary and secondary data, workshops and seminars with the participation of the population, and validation of the results. One of the main discoveries was that Guiana’s coastline has more problems than socio-environmental conflicts, although these are not absent. The main problems and conflicts are related to precarious environmental sanitation, urban sprawl, pollution of water resources and degradation of natural environments, such as the mangrove and Atlantic forest. We concluded that many of the diagnosed problems are causes for possible future conflicts, and the existing conflicts are mediated by the local government, which ends up deciding based on their own interests. The poor population is the one who suffers the most with the existing problems, absorbing the burden of environmental degradation on the coast; but there isn’t any organized confrontation group of these communities to overcome problems and mediate conflicts yet. Keywords: socio-environmental conflicts, coast, local population, Goiana. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabela normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

The objective was to understand and analyze the experiences of Afro-Brazilian women regarding pregnancy, delivery and postpartum care. It involves empirical research, with a qualitative approach. Women were interviewed who declared themselves black or colored and were attended in the public health services in the municipalities of the State of Pernambuco. The narratives were collected through semi-structured interviews. The Content Analysis technique was used. The narratives addressed the issues of obstetric violence and institutional racism. The intersection of levels of oppression such as race, class and gender are determinant in interventions and abusive practices in the helathcare that involves childbirth. The conclusion drawn is that structural racism hinders and denies access to black women to their reproductive rights.Objetivou-se compreender e analisar as vivências de mulheres negras acerca dos cuidados na gestação, no parto e no pós-parto. Trata-se de uma pesquisa empírica, de abordagem qualitativa. Foram entrevistadas mulheres que se autodeclaram negras ou pretas e que passaram pelos serviços públicos de saúde nos municípios de Pernambuco. As narrativas foram coletadas por meio de entrevista semiestruturada. Foi utilizada a técnica de análise de conteúdo. As narrativas discorrem sobre os temas da violência obstétrica e do racismo institucional. A interseção de eixos de opressão, como raça, classe e gênero, são determinantes nas intervenções e práticas abusivas na atenção que envolve o parto. Conclui-se que o racismo estrutural dificulta e nega o acesso das mulheres negras aos seus direitos reprodutivos.

Background: Children with congenital Zika syndrome (CZS) have a wide range of additional healthcare needs. This study aimed to estimate the direct costs of CZS from the health provider and family perspectives, and the indirect costs for families, in two Brazilian states: Rio de Janeiro and Pernambuco. Methods: A case-control study was undertaken between May 2017-January 2018 recruiting 174 cases with severe CZS, 41 with mild/moderate CZS and 269 children with no CZS, across the two sites, from existing studies. The primary caregiver was interviewed using a structured questionnaire to collect information on healthcare use and costs incurred during the previous 12 months. In Rio de Janeiro, health care utilization data was also extracted from electronic medical records. We estimated direct and indirect costs incurred as a result of CZS from the perspective of the health system and families. Results: Children with CZS accessed more healthcare facilities and reported longer travel and waiting times than children unaffected by CZS. Total costs from the health provider perspective of outpatient visits, were highest for children with severe CZS (U$1,411) followed by children with mild/moderate CZS (U$264) and children without CZS (U$107). This pattern was apparent for direct costs incurred by families, while median indirect costs were low. Families of children with CZS reported high levels of catastrophic expenditures; Expenses incurred by families to meet their child’s needs as a proportion of household income was 30% (IQR=14%-67%, p Conclusions: Families of children affected by CZS in Brazil may need additional public health resources and social benefits to protect them from incurring catastrophic expenses while meeting the needs of their children.

Social science generates evidence necessary to control epidemics. It can help to craft appropriate public health responses, develop solutions to the epidemic impacts and improve understanding of why the epidemic occurred. Yet, there are practical constraints in undertaking this international research in a way that produces quality, ethical and appropriate data, and that values all voices and experiences, especially those of local researchers and research participants. In this paper, we reflected on the experience of undertaking social science research during the 2015/2016 Zika epidemic in Brazil. This experience was considered from the perspective of this paper’s authors: three Brazilian academics, two UK academics and two mothers of children affected by congenital Zika syndrome. This group came together through the conduct of the Social and Economic Impact of Zika study, a mixed-methods social science study. The key findings highlight practical issues in the achievement of three goals: the conduct of high-quality social science in emergencies and efforts towards the decolonisation of global health in terms of levelling the power between Brazilian and UK researchers and optimising the role of patients within research. From our perspective, the information collected through social science was valuable, providing detailed insight into the programmatic needs of mothers and their affected children (eg, economic and social support and mental health services). Social science was considered a low priority within the Zika epidemic despite its potential importance. There were logistical challenges in conducting social science research, foremost of which are the difficulties in developing a trusting and balanced power relationship between the UK and Brazilian researchers in a short time frame. When these issues were overcome, each partner brought unique qualities, making the research stronger. The mothers of affected children expressed dissatisfaction with research, as they were involved in many studies which were not coordinated, and from which they did not see a benefit. In conclusion, the importance of social science in epidemics must continue to be promoted by funders. Funders can also set in place mechanisms to help equalise the power dynamics between foreign and local researchers, researchers and participants, both to promote justice and to create best quality data.

Horizonte 2020, o Programa-Quadro de Pesquisa e Inovacao da Uniao Europeia, sob o acordo de subvencao da Rede Latino-Americana de Prontidao para Zika (ZikaPLAN) n. 734584 do Departamento para o Desenvolvimento Internacional do Reino Unido (DFID) e Wellcome Trust (206016 / Z / 16 / A). Conselho Nacional de Pesquisa (CNPq) e Fundacao de Amparo a Pesquisa do Estado do Rio de Janeiro (FAPERJ); financiamento da produtividade em pesquisa para os alunos MCN Moreira e MEL Moreira.

The analysis of health policies has improved in Brazil despite a plethora of different methodological approaches. Based on the model developed by Walt and Gilson in 1994, the Environmental Health Program (EHP) of Recife as a policy based on the Health Promotion principles of the Unified Health System (SUS) and Agenda 21 was analyzed. An attempt was made to understand the context during the development and implementation of the EHP, the drafting process and which actors influenced the EHP agenda content and proposal. A qualitative case study was conducted, with semi-structured interviews with key actors. In terms of context, the findings include the influence of the municipal election, the socio-sanitary characteristics of Recife, the choice of the Secretary of Health and the management teams, acceptance by the technicians and the funding increase. In terms of the process, the acceptance of the managers must be stressed. Regarding the actors, the managers, sector technicians, non-sectorial actors with viability studies stood out. The content of the EHP coincided with the SUS and Health Promotion principles. Implementation was influenced by the dengue fever epidemic (2002), and cultural institutional factors that put pressure on the order of implementation of the planned actions.

OBJECTIVE Develop an index to evaluate the maternal and neonatal hospital care of the Brazilian Unified Health System.METHODS This descriptive cross-sectional study of national scope was based on the structure-process-outcome framework proposed by Donabedian and on comprehensive health care. Data from the Hospital Information System and the National Registry of Health Establishments were used. The maternal and neonatal network of Brazilian Unified Health System consisted of 3,400 hospitals that performed at least 12 deliveries in 2009 or whose number of deliveries represented 10.0% or more of the total admissions in 2009. Relevance and reliability were defined as criteria for the selection of variables. Simple and composite indicators and the index of completeness were constructed and evaluated, and the distribution of maternal and neonatal hospital care was assessed in different regions of the country.RESULTS A total of 40 variables were selected, from which 27 single indicators, five composite indicators, and the index of completeness of care were built. Composite indicators were constructed by grouping simple indicators and included the following variables: hospital size, level of complexity, delivery care practice, recommended hospital practice, and epidemiological practice. The index of completeness of care grouped the five variables and classified them in ascending order, thereby yielding five levels of completeness of maternal and neonatal hospital care: very low, low, intermediate, high, and very high. The hospital network was predominantly of small size and low complexity, with inadequate child delivery care and poor development of recommended and epidemiological practices. The index showed that more than 80.0% hospitals had a low index of completeness of care and that most qualified heath care services were concentrated in the more developed regions of the country.CONCLUSIONS The index of completeness proved to be of great value for monitoring the maternal and neonatal hospital care of Brazilian Unified Health System and indicated that the quality of health care was unsatisfactory. However, its application does not replace specific evaluations. OBJETIVO Desenvolver índice para avaliar a assistência hospitalar materna e neonatal do Sistema Único de Saúde.MÉTODOS Estudo descritivo de corte transversal, com abrangência nacional, com base na tríade estrutura-processo-resultado proposta por Donabedian e na integralidade da assistência. Utilizaram-se dados do Sistema de Informações Hospitalares e do Cadastro Nacional de Estabelecimentos de Saúde. Conformaram a rede materna e neonatal do SUS, 3.400 hospitais que realizaram pelo menos 12 partos/2009, ou cujo número de partos realizados representassem 10,0% ou mais no total de internações/2009. Relevância e confiabilidade foram definidas como critérios para seleção das variáveis a serem utilizadas. Foi realizada a construção e valoração dos indicadores simples, compostos e do índice de completude, e distribuição da rede hospitalar materna e neonatal nas regiões do País.RESULTADOS Selecionaram-se 40 variáveis a partir das quais foram construídos 27 indicadores simples, cinco indicadores compostos e o índice de completude. Os indicadores compostos foram construídos a partir da agregação dos indicadores simples, conformando as dimensões: porte hospitalar, complexidade, prática assistencial ao parto, práticas hospitalares recomendáveis e práticas epidemiológicas. O índice de completude agregou as cinco dimensões, fracionado em ordem crescente, originando cinco níveis de completude da assistência hospitalar materna e neonatal: baixíssima, baixa, intermediária, alta e altíssima. A rede hospitalar foi predominantemente de pequeno porte, baixa complexidade, com desempenho inadequado das práticas assistenciais ao parto e com baixo desenvolvimento das práticas recomendáveis e epidemiológicas. O índice mostrou que mais de 80,0% dos hospitais apresentam baixa completude e que os serviços mais qualificados concentraram-se nas regiões mais desenvolvidas do País.CONCLUSÕES O índice de completude mostrou ser de grande valor para o monitoramento da assistência hospitalar materna e neonatal do Sistema Único de Saúde e apontou que a qualidade dessa assistência foi insatisfatória. No entanto, seu emprego não substitui avaliações específicas.

This paper assesses inpatient and outpatient care and their capacity to respond to changing demands in the context of the demographic transition in Brazil. The data were obtained from studies by the Brazilian Institute of Geography and Statistics (IBGE) and databases in the National Health System (CNES, SIH, and SIA). The reduction in birth, fertility, and infant mortality rates and the increase in life expectancy at birth are still driving population growth, while decreasing the dependency rate, thereby providing the opportunity to make necessary adjustments. The population increased by more than 27.5 million from 1999 to 2009, with a 26.7% reduction in hospital beds and 947,000 hospitalizations, with distortions in the distribution by specialty, but with increases in high-complexity outpatient and inpatient care. The results show that Brazil is undergoing a transition in the healthcare model, requiring greater capacity for future planning of a more complex system and revising the model to prepare for a larger elderly population in the coming decades.

The objective of this paper was to explore the potentialities of the Hospital Information System - SIH/SUS for epidemiologic surveillance and monitoring of Notifiable Diseases. The states and regions of Brazil constituted the study area. Data relative to hospital admittances for Notifiable Diseases, during the period from 1984 to 1998, was obtained from the SIH/SUS and data from the National Center of Epidemiology – CENEPI, during the period from 1980 to 1997. Data bases were linked by pathologies, hospital admittances and by place of occurrence - distributed for states and regions of the country. The results of the classification of the states according to the four larger absolute frequencies of admittances and reports and the comparison between the reports and the number of admittances according to the need of admittances for the pathologies, showed a high level of coherence between CENEPI and SIH data. It was concluded that SIH/SUS has a great agility in obtaining the data and shows a good capacity for monitoring the analyzed pathologies, being an important complementary source of information for surveillance of Notifiable Diseases.